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HomeMy WebLinkAbout25F - AGMT - PARAMEDIC BILLING SRVSREQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: JUNE 17, 2014 TITLE: AGREEMENT FOR PARAMEDIC/ MEDICAL BILLING AND COLLECTION SERVICES _ I / CITY 44MAN R RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: ❑ As Recommended ❑ As Amended ❑ Ordinance on 1" Reading ❑ Ordinance on 2ntl Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO FILE NUMBER Approve and authorize the City Manager and Clerk of the Council to execute the attached agreement with Wittman Enterprises, LLC for a three -year period for paramedic /medical billing and collection services beginning July 1, 2014 (based on a contingent collection fee of 6% - year one; 6.15% - year two; and 6.3% - year three) to include an option at the election of the City to transfer administration, promotion, billing, and collection of the City's Paramedic Subscription Program, subject to non - substantive changes approved by the City Manager and City Attorney. DISCUSSION The Treasury Division of the Finance and Management Services Agency is responsible for administering the City's paramedic /medical billing and collection services agreement. Wittman Enterprises, LLC is the incumbent service provider and has performed paramedic/medical billing and collection services for the City since 1994. The primary tasks of the paramedic /medical billing and collection services provider are: • to assure that the City is reimbursed in a timely manner for emergency medical services and transport that the City provides through its contracts with the Orange County Fire Authority (OCFA) and CARE Ambulance; • to maximize the legal reimbursement to the City from all sources, including but not limited to: Medicare, Medi -Cal, and private insurance; • to manage provider compliance with Medicare and Medi -Cal to insure the City has a record of clean claims and a history of proper billing; • to supply comprehensive revenue recovery involving appeal of Medicare, Medi -Cal, and private insurance denials, researching of all private pays to find viable insurance, and working with patients to arrange alternate methods of repayment; and • to help coordinate patient participation in the City's Paramedic Subscription Program with other insurance coverage payments. 25F -1 Agreement for Paramedic /Medical Billing and Collection Services June 17, 2014 Page 2 On March 20, 2014, a notice inviting bids was advertised on the City's online bid management and publication system. A summary of the RFP solicitations and the proposals received is as follows: 13 Vendors were electronically notified 6 Vendors downloaded the bid packet 0 Bids received from Santa Ana Vendors 1 Bid received The one qualified bidder responding was Wittman Enterprises, LLC (Wittman). A committee composed of City and OCFA staff reviewed Wittman's proposal and interviewed senior Wittman staff. Based on the evaluation of the committee, Wittman's proposal was found to be responsive to the needs of the City: Wittman's fees are contingent upon successful billing and collection of paramedic /medical services provided through the City's contracts with the OCFA and CARE Ambulance. Wittman's current fee rate is 6.3 %. Wittman's proposed fee rates over the term of a three year agreement are as follows: (Agreement Year 1) — 6% of net collections (Agreement Year 2) — 6.15% of net collections (Agreement Year 3) — 6.3% of net collections In addition to administering the City's paramedic /medical billing and collection services agreement, the Treasury Division of the Finance and Management Services Agency is responsible for managing the City's Paramedic Subscription Program. Currently, over 6,500 City households participate in the program at an annual membership fee of $50.96 generating over $150,000 annually. As an add -on option to a new paramedic /medical billing and collection services agreement, Wittman proposes to adopt, promote, administer & collect the City's Paramedic Subscription Program. As part of its offer Wittman proposes the following services: • An initial mass mailing to promote participation in the City's Paramedic Subscription Program. Wittman warrants that the initial mass mailing list will total approximately 20,000 accounts. • An annual renewal mailer to all registered Paramedic Subscription Program members. • Wittman will generate and send a Paramedic Subscription Program membership mailer to all non - subscription paramedic /medical service recipients on an ongoing basis to further promote the program. • Wittman will collect all Paramedic Subscription Program applications and membership fees for processing. 25F -2 Agreement for Paramedic /Medical Billing and Collection Services June 17, 2014 Page 3 The proposed cost for Wittman's Paramedic Subscription Program service will be applied to fees collected and is as follows: ➢ Initial and subsequent renewal mailings - $1.00 per account. ➢ Administration of the City's subscription program: (Year 1) - 12% of subscription membership fees collected. (Year 2) - 11 % of subscription membership fees collected. (Year 3) - 10% of subscription membership fees collected. In order to implement third party administration of the Paramedic Subscription Program through Wittman, Medicare requires that a jurisdiction maintain a certain paramedic subscription fee threshold to meet Medicare Part B cost - sharing guidelines. This would require the City to increase its current annual subscription fee from $50.96 to $65. Participation in the optional City Paramedic Subscription proposal is elective on the part of the City and can be exercised by the City Manager or his designee for the first agreement year, prior to January 1, 2015, and thereafter prior to July 1St for any subsequent agreement year. Based on the potential to more efficiently promote and administer the City's Paramedic Subscription Program and thereby expand participation by Santa Ana residents, staff recommends inclusion of this option. FISCAL IMPACT As payment for services is contingent upon successful collection, Wittman will share in the total revenue recovered from their billing /collection efforts and paid from the Fire Services Contract Services Professional account no (01115330- 62300). ± N''i�Lj\�_Lrr 1 3 Francisco Gutierrez Executive Director I Finance & Management Services Agencyl�� FG /wh Exhibit: Agreement with Wittman Enterprises, LLC; 25F -3 25F -4 AGREEMENT FOR PROFESSIONAL AMBULANCE BILLING SERVICES BETWEEN THE CITY OF SANTA ANA AND WITTMAN ENTERPRISES, LLC THIS AGREEMENT, made and entered into this 17`h day of June, 2014 by and between Wittman Enterprises, LLC, a California Limited Liability Company (hereinafter "Consultant "), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City "). RECITALS A. The City desires to retain a consultant having special skill in providing ambulance and paramedic billing and collection services for the City's Emergency Medical Services (EMS) and Emergency Medical Transport Services (EMTS) Programs. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: SCOPE OF SERVICES Consultant shall provide EMS and EMTS billing and collection services as set forth in Exhibit A, attached to this Agreement and incorporated by reference. At the election of City, and upon written notification by the City Manager or his designee to Consultant, Consultant shall provide paramedic membership subscription services to include: outreach, solicitation, collection, and administration services as set forth in Exhibit B, attached to this Agreement and incorporated by reference. 2. TERM This Agreement shall commence on July 1, 2014 and terminate on June 30, 2017, unless terminated earlier in accordance with Section 12, below. Services provided beginning July 1, 2014, shall be within the Scope of Services of this Agreement. 25F -5 3. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services a percentage fee of net collections obtained by Consultant per contract year as follows: i. Agreement Year 1 - equal to 6.0 % of net collections obtained by Consultant. ii. Agreement Year 2 - equal to 6.15 % of net collections obtained by Consultant. iii. Agreement Year 3 - equal to 6.3% of net collections obtained by Consultant. b. Consultant shall bill for Emergency Medical Services at the rates established by City Council Resolution. c. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing collections received by City, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer- employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Due to the nature of services provided, Commercial General Liability insurance is not required. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self - insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than s 1,000,000 per accident. 25F -6 6. INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the Consultant or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information' shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non -use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by facsimile or other telegraphic communication in the manner provided in this Section, to the following persons: 25F -7 To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M -30) P.O. Box 1988 Santa Ana, California 92702 -1988 Facsimile (714) 647 -6956 Copy to: Executive Director of Finance and Management Services City of Santa Ana 20 Civic Center Plaza (M -17) P.O. Box 1988 Santa Ana, California 92702 Facsimile (714) 647 -5414 fffJ City Attorney City of Santa Ana 20 Civic Center Plaza (M -29) P.O. Box 1988 Santa Ana, California 92702 Facsimile (714) 647 -6515 To Consultant: Wittman Enterprises 21 Blue Sky Court Sacramento, California 95828 Facsimile: (800) 906 -6552 Courtesy copy to: Jon Riese, Esquire Signature Law Group 3400 Bradshaw Road, Ste A -4A Sacramento, CA 95827 Facsimile: (916) 290 -7616 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by facsimile, communication shall be effective or deemed to have been given twenty -four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In 25F -8 the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant, nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 13. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement 25F -9 shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 15. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of her inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. c. Consultant agrees that, notwithstanding the existence of any dispute between the parties, insofar as possible under the terms of this Agreement, each party will continue to perform the obligations required of it during the continuation of any such dispute, unless enjoined or prohibited by any court. 25F -10 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: LISA STOR K Assistant City Attorney CITY OF SANTA ANA: DAVID CAVAZOS City Manager WITTMAN ENTERPRISES CORRINE WITTMAN -WONG Chief - Executive Officer Tax ID# FEIN # 68- 0456021 25F -11 EXHIBIT A SCOPE OF SERVICES A. GENERAL PERFORMANCE REQUIREMENTS Consultant shall provide the City of Santa Ana with Billing and Collection services for the City's Emergency Medical Services (EMS) and Emergency Medical Transport Services (EMTS) as specified herein. 1. BILLING Consultant shall prepare all invoices and follow -up mailings. Initial invoicing with both English and Spanish instructions will be on 8x11 billings and will be placed in envelopes, sealed and mailed, postage prepaid. Initial invoicing occurs within three (3) days of receipt of transport ticket. Initial invoicing is fully itemized statement stating all procedures and supplies. Toll Free 800 telephone number provided to patients. An initial telephone call will also be made at time of initial invoicing to elicit any insurance information from the patient or patient's family. If Consultant receives no answer on this call, Consultant will send and inquiry letter in addition to the initial invoice. The standard bill schedule is as follows: 1. Invoice in English and Spanish Immediately 2. Statement 30 days 3. Past Due 20 days 4. Final Demand 10 days 2. MEDICARE, MEDI -CAL Consultant shall electronically convey all Medicare and Medi -Cal invoices to the appropriate payor. All secondary insurance, coinsurance and co- payments for Medicare/Medi -Cal, shall be transferred to the appropriate pay source and promptly billed to that source Consultant shall be responsible for program updates if the requirements of Medicare and Medi -Cal fiscal intermediaries change during the contract period. 3. WORKERS' COMPENSATION AND PRIVATE INSURANCE Consultant shall bill private insurance, supplemental insurance, secondary insurance and workers compensation in accordance with applicable requirements. Electronic billing of insurance companies is performed where appropriate. Any correspondence for additional information or follow up necessary to secure insurance payment shall be performed by Consultant. In the event that members of the City's Paramedic Subscription Program have third party insurance, a diligent and timely effort shall be made by the Consultant to identify, bill, and pursue payment from these sources. Medi -Cal, Medicare, and Insurance company billing schedules shall be as needed. 25F -12 4. DELINQUENT CLAIMS Consultant shall track accounts requiring special handling and follow -up. Consultant will honor City requests for special handling of accounts including but not limited to elderly, handicapped and social dependent situations. Patients with claims aging over 45 days will be contacted by telephone for payment arrangements. Telephone follow up will continue until payment in full is received or account is dismissed by the City to an outside collection agency. Consultant will utilize installment billing as allowed by the City in cases of financial hardship. Accounts will be reviewed monthly so that accounts that have been deemed uncollectable are sent to the City's designated collection agency between 180 and 210 days. 5. RECEIPTS PROCESSING Consultant will receive copies of payments deposited by City and post those payments to the correct patient account within one (1) day of receipt. Consultant will forward to City any payments made directly to Consultant. 6. REPORTS Consultant shall perform accurate month end close procedures that will result in the following reports: a. Monthly Ticket Survey b. Monthly Sales Journal c. Monthly Cash Receipts Journal d. Monthly Receivables Aging e. Management Accounts Receivable Analysis f. Statistical Reports Reports shall be provided monthly and shall be transmitted electronically in Portable Document Format (PDF) and shall display in portrait page orientation. As deemed desirable by City, alternative reporting content or format may be adopted by mutual agreement of City and Consultant. B. RECORDS Consultant shall maintain records in accordance with generally accepted bookkeeping and accounting practices. Consultant must keep claim submission date, follow -up payments made on account, source of payment and automatic audit trail to assignment for collection. Consultant agrees that all account files remain the property of the City and will be returned to City at termination of this Agreement. Account file information including patient name, address, age, diagnosis, contact information, billing and payment information shall be updated as necessary to maintain accurate records. Patient records shall be cross referenced by name, Social Security number, address, date of birth, date of service and Paramedic Subscription program membership number. RECORDS RETENTION Consultant agrees to retain all source documents including attachments for seven (7) years. All Medicare and Medi -Cal audits for periods during which this contract is in effect shall be referred to Consultant. 25F -13 Consultant shall comply with City established policies, standards and security procedures and procedures relating to the release of information concerning injured or treated parties. C. CITY RESPONSIBILITIES • Submit necessary transport information, including pay source information and patient condition to Consultant for billing purposes • Forward to Consultant all necessary information relating to patient transport services, payments and patient eligibility • Notify Consultant of any accounts requiring special attention/handling • Obtain signature of patient or guardian • Provide patient's Social Security number 10 25F -14 EXHIBIT B OPTIONAL CITY PARAMEDIC SUBSCRIPTION MEMBERSHIP PROGRAM Adoption, promotion, and administration of City's Annual Paramedic Subscription Membership Program: 1. As a condition to participation in Optional City Paramedic Subscription Membership Program and to ensure that City is compliant with Medicare guidelines on subscription membership fees, City shall impose a minimum paramedic services subscription fee of not less than $65. 2. The City Manager or his designee shall inform Consultant in writing of City's decision to participate in Optional City Subscription Membership Program. 3. Upon receipt of City's written decision to participate in Optional City Paramedic Subscription Membership Program, Consultant shall assist City in generating and formatting an initial mass mailer to solicit participation by residents of the City of Santa Ana in the paramedic services subscription membership program. Consultant shall assist City in generating and formatting a renewal paramedic services subscription membership program mailer and will format that mailer for mass mailing. Basic mailer and renewal mailer shall include a multi - color, double -sided City Paramedic Subscription Membership Program solicitation letter /application and return envelope. Use of additional colors, inserts or enclosures may be added at the direction of the City. Consultant's cost shall reflect increased service costs, materials, and postage. Consultant shall prepare a statement of additional costs per mailing piece for approval by the City prior to incurring additional costs. 4. Consultant shall generate the City's initial mass mailing list from paramedic billing accounts listed in Consultant's database for fiscal years 2009 -10 through 2013 -14. Mailing list shall be comprised of all residential paramedic billing accounts in Consultant's billing system. Consultant warrants that the initial mass mailing list will total approximately 20,000 accounts. At the option of the City, alternate mass mailing lists can be developed reflecting shorter time periods. Consultant shall annually send a renewal mailer to all registered City Paramedic Subscription Membership Program members based on all registered City of Santa Ana subscribers in Consultant's database. 5. Consultant shall thereafter, on an on -going basis, generate and send an initial paramedic services subscription membership program mailer to all non - subscription paramedic service recipients upon payment or write -off of service recipient's paramedic services billing. 6. Consultant will receive and process each subscription application by adding the member to Consultant's system (profit center) and posting the payment. This database will be used to identify any subscription member that may be transported upon the input to Consultant's billing system. The City will receive separate monthly reports for the subscription program. 25F -15 7. Cost — The cost for Consultant's subscription membership program service is as follows: a. Initial and subsequent renewal mailings - $1.00 per account (to be applied as an offset to Paramedic Subscription Program billing collections). b. Administration of the City's subscription program — 10% of paramedic subscription membership fees collected. i. Agreement Year 1 - 12% of subscription membership fees collected. ii. Agreement Year 2 - 11 % of subscription membership fees collected. iii. Agreement Year 3 - 10% of subscription membership fees collected. Participation in the optional City Paramedic Subscription Membership Program shall be elective on the part of the City and can be exercised by the City Manager or his designee for the first agreement year, prior to January 1, 2015, and thereafter prior to July I" for any subsequent agreement year. 12 25F -16